Provider Demographics
NPI:1962752634
Name:SCARPULLA, JUSTIN ANGELO (PHARMD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ANGELO
Last Name:SCARPULLA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:583 CARLTON BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3051
Mailing Address - Country:US
Mailing Address - Phone:718-772-1785
Mailing Address - Fax:
Practice Address - Street 1:895 W BAY AVE
Practice Address - Street 2:
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-2121
Practice Address - Country:US
Practice Address - Phone:609-698-2329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03517500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist